A Lean Healthcare Job Interview Process: Thoughts and Reflections
Mark's Note: I asked my friend Sam Selay to write a blog post on this topic after some private discussions that we had. He agreed and shared this post. I've talked to many others who have run into similar roadblocks and frustrations when trying, with the best of intentions, to bring their Lean skills and experience into healthcare.
Sam was one of the contributing authors to the anthology “Practicing Lean,” which is now available through Apple iBooks, in addition to Amazon (Kindle and paperback), and Leanpub (eBook and audiobook). Here is his post:
In June, I was informed by my employer that the company had decided to go in a new direction. They said they would now build lean into their processes and enable process owners to be responsible for all continuous improvement functions. To date, I don't know many organizations that have been able to successfully embed lean into everyone's work and sustain it.
While this move left me unemployed, it could not have come at a better time. My kids had just started summer break from school and I got to spend the whole summer with them enjoying Southern California where I reside.
As I began exploring new opportunities in Lean, I used this as an opportunity to attempt to get into healthcare to practice Lean. Until this point, I had only practiced Lean in the Department of Defense, government, and manufacturing.
For me, I wanted to try to get into healthcare for several reasons: it's broken, errors are occurring, and costs are rising due to the poor quality of care. Some have gone as far to say that medical errors are now the third leading cause of death in the United States. Here is a report by Johns Hopkins on this subject, written in 2016. And Mark shares some other statistics here.
Additionally, being a 13-year United States Marine Corps veteran with 4 surgeries while on active duty, I can candidly say that there is room for improvement in healthcare for active duty and veterans through the Department of Veterans Affairs. I would one day like to help improve the Department of Veterans Affairs healthcare system through the deployment of Lean as a philosophy and management system. Whether it's healthcare in the private sector or government, there are great opportunities to use Lean to improve patient safety, quality of care, and service.
After applying to numerous Lean healthcare roles, I finally got an interview. The position seemed to be a good fit for what I was looking for. The position summary read: “Partners with managers and employees to facilitate, create and implement process and systems improvement (Lean Healthcare).” The job posting also went on to say the person in that role would “promote a true Lean culture.”
In the job posting, there was a line that didn't sit right with me. As it turned out, when I had the opportunity to ask questions about this, it completely painted the picture of what leadership's real expectations and focus were at their healthcare system.
“Willing to do diverse work to assist anyone or any team in the hospital to reduce waste in the lean sense, reduce defects, reduce cost in the traditional sense, improve productivity, increase revenue or volumes, and take time and complexity out of processes.”
Working in other settings, I have found that leaders care a lot about cost, efficiency, and productivity, even though safety, quality, and service are supposedly what the company cares most about, as outlined in numerous company documents and policies.
When I asked about this sentence, I was told that cost savings was leadership's top focus. The interviewer went on to inform me that the healthcare system has been cutting costs by laying staff off and increasing staff utilization to increase productivity, which resulted in a reduction in costs.
I was informed that I would be responsible for finding ways to further reduce costs through Lean. Laying off staff is NOT Lean. There comes a time when organizations must use layoffs to stay profitable. I was just part of a wave of layoffs, which included the whole Lean department.
The hospital can choose to cut costs through layoffs, but they should not be calling it “Lean.” Toyota, who is arguably the founder of Lean coming from the Toyota Production System, has emphasized that Lean is focused on improving flow and quality. In more recent years maximizing customer value has been a broader use of Lean.
The Lean Enterprise Institute has defined lean as creating more value for customers with fewer resources.
How then do layoffs and increasing staff utilization resemble anything close to Lean? While increasing utilization may reduce costs, it may hinder flow when there is a rush of patients. I don't think you would want your fire department at 100% utilization.
In fact, I'm currently living through three of California's largest fires in state history. My kids' school has been closed due to poor air quality. I'm thankful that the fire departments around the state have the capacity to support and fight these fires. What is going to happen when the ER at this hospital who's boasting at being at a high utilization rate has a surge of patients?
Prior to the completion of the interview, the conversation turned toward compensation. It was here that I learned that the pay range for the role was much lower than the rate I had been earning in previous roles outside of healthcare — close to 50% lower. This aligned with what I was told earlier about the focus on cost cutting. My perception of the low compensation is that the executives don't value Lean and didn't want to commit to a pay range that was commensurate to leaders in the healthcare system. I sensed that Lean was something that is “delegated” to someone else, or someone that is “beneath them.”
My experience interviewing with this healthcare system was a learning lesson. After that interview, I decided that I did not want to move forward with the role due to leadership not truly understanding that Lean is not only a set of tools that can be used to cut costs, but is also a philosophy and a management system.
I didn't understand how they got the idea that Lean's purpose was to cut costs. Also, to allude to what I just said, the low compensation for the role also indicated to me that the executives really didn't value Lean. They needed someone to find ways to cut costs and do other “Lean things” to hide the fact that they were really only focused on cost reduction.
Again, Lean can't be delegated it must be lead by senior leaders. To quote leadership author John Maxwell, “Everything rises and falls on leadership.”